J Korean Assoc Pediatr Surg.  2018 Jun;24(1):30-34. 10.13029/jkaps.2018.24.1.30.

Bile Duct Stricture and Intrahepatic Cystic Formation after Abdominal Injury due to Child Abuse: A Case Report

• Ihn K
• Koo EJ
• Ho IG
• Lee D
• Han SJ

• KMID: 2415884
• DOI: http://doi.org/10.13029/jkaps.2018.24.1.30

Abstract

A 6-year-old male who lived with a mother in a single-parent family was referred to the emergency room with multiple traumas. There was no specific finding on CT scan of the other hospital performed 55 days before admission. However, CT scan at the time of admission showed common bile duct (CBD) stenosis, proximal biliary dilatation and bile lake formation at the segment II and III. Endoscopic retrograde biliary drainage was performed, but the tube had slipped off spontaneously 36 days later, and follow-up CT scan showed aggravated proximal biliary dilatation above the stricture site. He underwent excision of the CBD including the stricture site, and the bile duct was reconstructed with Roux-en-Y hepaticojejunostomy. Pathologic report of the resected specimen revealed that the evidence of trauma as a cause of bile duct stricture. While non-iatrogenic extrahepatic biliary trauma is uncommon, a level of suspicion is necessary to identify injuries to the extrahepatic bile duct. The role of the physicians who treat the abused children should encompass being suspicious for potential abdominal injury as well as identifying visible injuries.

Keyword

Child abuse; Bile duct; Multiple trauma; Blunt injury

MeSH Terms

Abdominal Injuries*
Bile Ducts*
Bile Ducts, Extrahepatic
Bile*
Child
Child Abuse*
Child*
Common Bile Duct
Constriction, Pathologic*
Dilatation
Drainage
Emergency Service, Hospital
Follow-Up Studies
Humans
Lakes
Male
Mothers
Multiple Trauma
Single-Parent Family
Tomography, X-Ray Computed
Wounds, Nonpenetrating

Figure

• 

  Fig. 1 Contrast-enhanced abdominal CT scan. (A) CT scan taken two months before admission shows no visible bile duct dilatation or bile lake in the upper abdomen. (B) CT scan taken at the admission shows stenosis at proximal common bile duct with common hepatic duct dilatation and a bile lake at S2/3 of the liver.

• 

  Fig. 2 Timeline plot of clinical course. CBD, common bile duct; ERBD, endoscopic retrograde biliary drainage.

• 

  Fig. 3 The changes and trends of each liver function tests. TB, total bilirubin; GGT, gamma-glutamyl transpeptidase; ERBD, endoscopic retrograde biliary drainage.

• 

  Fig. 4 (A) CT scan taken at the 2nd admission shows the distal migration of endoscopic retrograde biliary drainage catheter with aggravated proximal biliary dilatation above the stricture site of mid-common bile duct. (B) Cholangiography during the operation.

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  Fig. 5 Linear capsular fibrotic change on the left 3 cm from the falciform ligament (arrows).

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